Endoscopic “step-up approach” using a dedicated biflanged metal stent reduces the need for direct necrosectomy in walled-off necrosis (with videos)

Self Cite

Section: N the Present Study Eus-guided Drainage Of Pfc Inmentioning

confidence: 99%

Endoscopic drainage of pancreatic fluid collections: Long‐term outcomes in children

Nabi

Lakhtakia

Basha

et al. 2017

Self Cite

“…The novel saddle‐shaped lumen‐apposing fully covered self‐expanding metal stent (LAMS) has been reported to have a high success rate for drainage debridement of WON . In addition, it was recently reported that treatment of WON is improved by carrying out continuous irrigation in addition to EUS‐D using a FCSEMS and a LAMS before endoscopic necrosectomy . However, FCSEMS and LAMS are more expensive than DPS.…”

Section: Discussionmentioning

confidence: 99%

Radical treatment for walled‐off necrosis: Transmural nasocyst continuous irrigation

Tamura

Itonaga

Tanioka

et al. 2019

Background and Aim Treatment efficiency of walled‐off necrosis (WON) using endoscopic ultrasound‐guided drainage (EUS‐D) with a double pigtail stent (DPS) is limited. Endoscopic necrosectomy is often carried out if EUS‐D fails. However, endoscopic necrosectomy is associated with significant morbidity and mortality. Thus, we developed transmural nasocyst continuous irrigation (TNCCI) as an alternative therapeutic option for WON. This study aimed to evaluate the usefulness of TNCCI therapy for WON. Methods Between April 2009 and March 2018, 19 of 39 patients admitted with WON underwent EUS‐D. Ten consecutive patients also received TNCCI therapy (TNCCI group) between May 2015 and March 2018. TNCCI was carried out by inserting an external tube from the gastroduodenal lumen into the WON under endoscopic ultrasonography guidance and then continuously irrigating the WON with saline at a rate of 40 ml/h. Nine consecutive patients who underwent EUS‐D without TNCCI therapy between April 2009 and April 2015 were used for comparison (control group). Various parameters were compared between the TNCCI and control groups. Results Time taken to reduce WON (6 vs 32 days, P = 0.001), implementation rate of endoscopic necrosectomy (0% vs 55.6%, P = 0.01), and number of endoscopic necrosectomy sessions per patient (0 vs 0.8 ± 1.0, P = 0.008) were significantly lower in the TNCCI group than in the control group. Conclusions Walled‐off necrosis can be effectively and safely treated by endoscopic drainage with a DPS and TNCCI. This technique can be an alternative therapeutic option before carrying out endoscopic necrosectomy.

“…Endoscopic ultrasonography‐guided transmural drainage of pancreatic pseudocysts and walled‐off necrosis (WON) is emerging as a minimally invasive alternative to surgery. These procedures are technically demanding but relatively safe in expert hands (perforation, bleeding, stent migration/occlusion, and infection can occur in 4–21% of cases) . Plastic stents have been widely adopted for transmural drainage of pancreatic pseudocysts with clear contents.…”

Section: Interventional Eus: New Tools New (And Old) Applicationsmentioning

confidence: 99%

Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Tontini

Manfredi

Orlando

et al. 2019

Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.